Relative to long-term care eligibility and making an appropriation therefor.
Summary
SB 131 would create a provisional eligibility process for Medicaid nursing facility services during the long-term care application review period. Under the bill, the Department of Health and Human Services would be required to grant provisional eligibility within 90 days of receiving a long-term care medical assistance application, even if the application is incomplete, so long as the nursing facility agrees by contract to participate. While the applicant is provisionally eligible, the department would pay the facility at the same rate as a fully eligible Medicaid recipient until a final eligibility decision is made.
The provisional eligibility period would generally last up to 18 months from the application date, but it could end earlier if the application is approved or denied, or if the facility requests termination. If final approval has not been issued within 12 months, the provider may seek appointment of a special Medicaid representative. The bill also requires facilities that receive provisional payments to reimburse the department after final determination, and it authorizes sanctions for failure to repay. In addition, the bill appropriates $1.5 million for the program, creates two DHHS positions to administer it, and allows additional funding with fiscal committee and governor and council approval if costs exceed the appropriation.
Impact
The bill would amend RSA 167:8 to add a new provisional Medicaid nursing facility eligibility framework and would also amend RSA 167:18-a to clarify that counties are not liable for provisional eligibility appropriations or payments. It would establish a state-funded, contract-based payment and reimbursement mechanism for nursing facility care while long-term care applications are pending, and it would create new administrative responsibilities and staffing within DHHS. The fiscal note indicates the bill could have substantial General Fund exposure, with expenditures projected to exceed the initial appropriation if many pending applications qualify and facilities participate.
Sentiment
The available context suggests support for addressing delays in long-term care Medicaid determinations, especially where incomplete applications have left nursing facilities waiting for payment decisions. The bill’s structure indicates an effort to keep care flowing while applications are pending and to reduce uncertainty for providers and applicants. At the same time, the fiscal note shows the proposal is viewed as potentially expensive and operationally significant, which likely tempers enthusiasm among budget-conscious stakeholders.
Contention
The main point of contention is fiscal risk: DHHS estimates the bill’s costs could far exceed the $1.5 million appropriation, potentially reaching tens of millions of dollars if provisional eligibility is widely used. Another issue is administrative feasibility, since the bill would require DHHS to make provisional eligibility determinations within 90 days even when applications are incomplete, and it would rely on provider contracts and later reimbursement to function as a revolving fund. Providers may support faster payment, while fiscal and administrative stakeholders may be concerned about repayment timing, participation rates, sanctions for nonpayment, and the need for additional appropriations through the open-warrant process.
Elections: voting procedures; process for voting without identification for election purposes; modify to include proof of identity and proof of state residency. Amends secs. 523, 523a, 813 & 829 of 1954 PA 116 (MCL 168.523 et seq.).